Provider Demographics
NPI:1780044982
Name:AJC MEDICAL GROUP
Entity Type:Organization
Organization Name:AJC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHARLOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-603-8200
Mailing Address - Street 1:1498 NW 54TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-3861
Mailing Address - Country:US
Mailing Address - Phone:305-603-8200
Mailing Address - Fax:305-603-8461
Practice Address - Street 1:1498 NW 54TH ST STE C
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-3861
Practice Address - Country:US
Practice Address - Phone:305-603-8200
Practice Address - Fax:305-603-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty